Medical Claims & Appeals Specialist

RECRUIT EXPRESS PTE LTD; Singapore; On-site; SGD 40,000 - 60,000; Full time

Job summary

RECRUIT EXPRESS PTE LTD is seeking a diligent medical insurance claims specialist to assess and process claims in Singapore, ensuring accuracy and adherence to service standards.

You will review medical documents and policy terms to determine eligibility and payouts, manage investigations and appeals, liaise with policyholders and providers, and contribute to process improvements while upholding regulatory requirements.

Responsibilities

• Assess and process medical insurance claims accurately and within service standards.
• Review policy terms and claim information to determine eligibility and payouts.
• Manage claim investigations, pending claims and appeals, ensuring timely resolution and adequate reserves.
• Identify unusual claim patterns, potential risks and areas for improvement in claims processes and controls.
• Liaise with policyholders, medical institutions, intermediaries and internal stakeholders to clarify medical information and outstanding requirements.
• Provide professional and empathetic support to customers throughout the claims process.
• Ensure claims decisions and processes comply with company policies, regulatory requirements and internal controls.
• Monitor industry and regulatory developments and highlight potential compliance or operational risks.
• Contribute to process improvement initiatives and service excellence projects.
• Perform other duties and projects as assigned by management.

Job description

RECRUIT EXPRESS PTE LTD is seeking a diligent medical insurance claims specialist to assess and process claims in Singapore, ensuring accuracy and adherence to service standards.

You will review medical documents and policy terms to determine eligibility and payouts, manage investigations and appeals, liaise with policyholders and providers, and contribute to process improvements while upholding regulatory requirements.